Evaluation times for patients with in-hospital strokes

Mark J. Alberts, Lawrence M. Brass, April Perry, Debbie Webb, Deborah V. Dawson

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background: Each year at least 35 000 people suffer a stroke while hospitalized, but little is known about the clinical characteristics of such patients or how rapidly they are identified and evaluated. With a recent emphasis on the very early treatment of stroke, in-hospital stroke patients may be candidates for some early interventions. Methods: This was a retrospective study using the stroke registries at two academic medical centers. Data were collected about the clinical characteristics of patients with an in-hospital stroke and who recognized the stroke. Detailed time data were analyzed to determine the time of stroke recognition, medical evaluation, and neurological evaluation. These specific time epochs were analyzed to determine which were responsible for any delays in stroke identification and assessment. Data were analyzed using nonparametric methods, including the Wilcoxon rank sum and Kruskal-Wallis procedure. Results: Sixty-three patients were identified with in-hospital strokes and adequate time data. In-hospital stroke patients were recognized most frequently by nurses (63%) and by the patient (16%). Patients on a cardiology service and general surgery service accounted for 48% of all in-hospital strokes. The mean and median times from stroke recognition to a neurology evaluation were 14.5 and 2.5 hours, respectively. Total delays differed significantly with service and locale (P=.004). Patients on the Duke neurology service were evaluated significantly sooner (median delay, 0.5 hour) than patients on the Duke medical (median delay, 5.8 hours) or Duke surgical (median delay, 20.5 hours; P<.01 by Wilcoxon rank sum) services. Patients on the Yale surgical service were evaluated significantly sooner than patients on the Duke medical (P=.0006) or surgical (P=.0001) services. The time between physician notification and calling for a neurology evaluation accounted for >60% of the total time delay for patients not on a neurology service. Conclusions: A substantial number of in-hospital stroke patients experience a long delay between symptom recognition and a neurological evaluation. While medical personnel are usually notified very soon after an in-hospital stroke is recognized, such patients often do not receive a rapid neurological evaluation. Additional education of hospital staff may reduce these time delays.

Original languageEnglish (US)
Pages (from-to)1817-1822
Number of pages6
JournalStroke
Volume24
Issue number12
StatePublished - Dec 1993

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Stroke
Neurology
Cardiology
Registries
Retrospective Studies
Nurses
Education

Keywords

  • Cerebrovascular disease
  • Cerebrovascular disorders
  • Epidemiology
  • Hospitalization
  • Stroke management

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Alberts, M. J., Brass, L. M., Perry, A., Webb, D., & Dawson, D. V. (1993). Evaluation times for patients with in-hospital strokes. Stroke, 24(12), 1817-1822.

Evaluation times for patients with in-hospital strokes. / Alberts, Mark J.; Brass, Lawrence M.; Perry, April; Webb, Debbie; Dawson, Deborah V.

In: Stroke, Vol. 24, No. 12, 12.1993, p. 1817-1822.

Research output: Contribution to journalArticle

Alberts, MJ, Brass, LM, Perry, A, Webb, D & Dawson, DV 1993, 'Evaluation times for patients with in-hospital strokes', Stroke, vol. 24, no. 12, pp. 1817-1822.
Alberts MJ, Brass LM, Perry A, Webb D, Dawson DV. Evaluation times for patients with in-hospital strokes. Stroke. 1993 Dec;24(12):1817-1822.
Alberts, Mark J. ; Brass, Lawrence M. ; Perry, April ; Webb, Debbie ; Dawson, Deborah V. / Evaluation times for patients with in-hospital strokes. In: Stroke. 1993 ; Vol. 24, No. 12. pp. 1817-1822.
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AB - Background: Each year at least 35 000 people suffer a stroke while hospitalized, but little is known about the clinical characteristics of such patients or how rapidly they are identified and evaluated. With a recent emphasis on the very early treatment of stroke, in-hospital stroke patients may be candidates for some early interventions. Methods: This was a retrospective study using the stroke registries at two academic medical centers. Data were collected about the clinical characteristics of patients with an in-hospital stroke and who recognized the stroke. Detailed time data were analyzed to determine the time of stroke recognition, medical evaluation, and neurological evaluation. These specific time epochs were analyzed to determine which were responsible for any delays in stroke identification and assessment. Data were analyzed using nonparametric methods, including the Wilcoxon rank sum and Kruskal-Wallis procedure. Results: Sixty-three patients were identified with in-hospital strokes and adequate time data. In-hospital stroke patients were recognized most frequently by nurses (63%) and by the patient (16%). Patients on a cardiology service and general surgery service accounted for 48% of all in-hospital strokes. The mean and median times from stroke recognition to a neurology evaluation were 14.5 and 2.5 hours, respectively. Total delays differed significantly with service and locale (P=.004). Patients on the Duke neurology service were evaluated significantly sooner (median delay, 0.5 hour) than patients on the Duke medical (median delay, 5.8 hours) or Duke surgical (median delay, 20.5 hours; P<.01 by Wilcoxon rank sum) services. Patients on the Yale surgical service were evaluated significantly sooner than patients on the Duke medical (P=.0006) or surgical (P=.0001) services. The time between physician notification and calling for a neurology evaluation accounted for >60% of the total time delay for patients not on a neurology service. Conclusions: A substantial number of in-hospital stroke patients experience a long delay between symptom recognition and a neurological evaluation. While medical personnel are usually notified very soon after an in-hospital stroke is recognized, such patients often do not receive a rapid neurological evaluation. Additional education of hospital staff may reduce these time delays.

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KW - Stroke management

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